VBS 2025 Registration Form

Please fill out this form separately for each child in your family. To help us plan, please register your child by July 7th.

Child Info

Name

Date of Birth

Gender

Female Male Non-Binary

Pronouns

She/Her/Hers He/Him/His They/Them/Theirs Other

If you chose Other, please share your child's pronouns

Age

Grade (Beginning This Fall)

Primary Address

Does your child have any food allergies? If so, please list.

We often serve a snack during our programming. Do you consent to us providing your child with a snack, keeping in mind that we will provide an alternative for any known allergies.

Yes No

Are there any behavioral or medical conditions we should be aware of? If so, please list.

Parent/Guardian Contact Info

Primary Parent/Guardian's Name

This address will receive a confirmation email

Cell Phone

Home Phone

Work Phone

Event Info

Which days do you estimate you will be attending VBS? (Check all that apply.) All week Monday, July 21 Tuesday, July 22 Wednesday, July 23 Thursday, July 24

Can you or another grown-up in your family help as a volunteer? Yes, count me in. Maybe, contact me as it gets closer. No, I can't help this time.

We will plan to serve dinner each night from 5-6 pm before VBS. What are the chances your family would attend dinner? (This isn't a commitment, but it will help us plan for numbers.) Very Likely Likely Unlikely

If you plan to attend dinner, how many people in your family will likely eat?

How did you hear about our VBS?

I'm a member of Bethlehem I'm a member of Centenary Facebook Mailing Friend or family member

Permissions

I give permission for my child to attend Vacation Bible School, taking part in the normal program activities. This may include walking in a group to and from either church building. I authorize Bethlehem Lutheran Church or Centenary United Methodist Church to secure a doctor to provide any necessary emergency medical care. I also give permission for the use of photographs, video, and electronic images including my child in church promotion for either Bethlehem or Centenary.

I agree (Checking agree acts as a signature)

Bounce House Waiver: If you choose "I do not agree", your child will not be able to participate in a bounce house activity during one of our VBS days. | On behalf of all children and adults in our care participating in activities at involving the inflatable bounce houses, I acknowledge and agree to the terms and conditions of this waiver as identified below: 1) There are risks, both known and unknown, using any inflatable or amusement device, including, but not limited to physical injury, emotional injury, distress, paralysis and even death. The risk of serious injury from participating in inflatable bounce house activities, although minimal, does exist, as it does in all play and amusement activities. 2) If the inflatable bounce house is being used outdoors, we take responsibility to make sure the bounce house is set up correctly. If there are wind gusts more than 10 MPH, Bethlehem Lutheran Church or Centenary UMC staff will remove all individuals from the inflatable bounce house and deflate it to insure the safety of all participants. 3) On the day we will be using the bounce house during VBS, a Bethlehem or Centenary staff member or volunteer will inform all children to follow all rules of participation. 4) I, on behalf of myself, my children, my family members, children in my care, my heirs and my guests, knowingly and freely assume all risks of injury and agree to hold harmless Bethlehem Lutheran Church and Centenary UMC, its staff and volunteers with respect to any claims, demands, causes or rights of action, even if arising from the actions, acts of omission or negligence of said entities or individuals.

I agree. (Checking agree acts as a signature) I do not agree. By checking this, you are choosing not to have your child participate in a VBS activity using a bounce house. (Checking I do not agree acts as a signature)

Dear Parent/Legal Guardian: By participating in programs, services, and activities of Bethlehem Lutheran Church and/or Centenary United Methodist Church, you agree to the following: On behalf of yourself and your children, you hereby release, covenant not to sue, discharge, and hold harmless Bethlehem or Centenary, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any hosted or programmed event by Bethlehem Lutheran Church and/or Centenary United Methodist Church.

I agree (Checking agree acts as a signature)

Questions or Comments

Any questions or comments? Or, is there anything that would be helpful for us to know?

VBS 2025 Registration Form

Description

Please Fix the Following